Peripheral arterial disease Flashcards
What is Peripheral Arterial Disease?
a range of arterial syndromes that are caused by atherosclerotic obstruction of the lower-extremity arteries.
What are the risk factors of PAD?
Smoking CVD HTN Diabetes Hyperlipidaemia Older Male FH
What are the symptoms of PAD?
Claudication relieved by rest in calf, thigh, buttocks.
Diminished pulse
What would you think with gangrene, non healing ulcer and vascular bed pain?
Critical Emergency Ischaemia
What is vascular bed pain?
Pain in the foot at rest, relieved by hanging legs over the end of the bed
What are the fontaine classifications of PAD?
- Asymptomatic
2a. Mild intermittent claudication
2b. Mod-severe intermittent claudication - Ischaemic rest pain
- Critical Ischaemia (decompensated PAD)
What are the 6 Ps of acute limb ischaemia?
Pale Pulseless Painful Paralysed Parasthesia Perishingly cold
What are the signs of PAD?
Cold, white legs Absent pulses Atrophic skin (ulcers, shiny) CRT > Loss of hair Thickened toenails Dry skin between toes
Is critical limb ischaemia the same as acute limb ischaemia?
NO - acute is an emergency
What tests do we do for PAD?
Exclude DM - Fasting Glc and HbA1c CRP- arteritis FBC - anaemia/polycythaemia UEs - renal disease Lipids - dyslipidaemia ECG - cardiac ischaemia ABPI Doppler
What are the relevance of results in ABPI?
A result of 1-1.2 is normal
0.5-0.9 = PAD
<0.5 = Critical Limb Ischaemia or <50mmHg
With what do you finish your vascular examination?
ABPI
Doppler
CV exam
BM glucose
How do we treat PVD?
Treat any risk factors: stop smoking control BP to <140 statins for cholesterol to reduce <5 or 25% T2DM treatment weight loss
Clopidogrel if not contraindicated, or aspirin 75mg OD
Manage claudication with a supervised exercise programme and Cilostazol to help claudication (100mg BD preprandial)
What is cilostazol?
Platelet inhibitor and vasodilator
What do we do if the lifestyle changes, supervised exercise programme, clopidogrel and cilostazel fails to help?
Consider revascularisation:
Duplex/doppler
MRA (angiography)
If suitable then can do:
Angioplasty and stent (Percutaneous transluminal angioplasty (PTA) )
If not suitable/failed then:
Bypass/grafting
Patient may make the decision to amputate (<3%)
How long do you have to save the limb in acute limb ischaemia?
4-6hours
What is the amputation and death rate of acute limb ischaemia?
Amputation 16%
Death 22%
What are the surgical options for Acute limb ischaemia?
Percutaneous thrombectomy
Angioplasty
Embolectomy
Amputation
Which drugs do we give in acute limb ischaemia?
tPA - anticoagulant
Heparin
What is vitamin K?
It is a coagulation therapy because vit K is a precursor for liver coagulation factors (2,7,9,10)
Pathophysiologically, what is the difference between chronic limb ischaemia and acute limb ischaemia?
Chronic ischaemia is a plaque causing lumen reduction
Acute ischaemia is a ruptured plaque that has thrombosed
Describe the order in which āPās come on in acute ischaemia, and the various management plans after each
Pale
Perishingly Cold
Pulseless
Painful
THIS IS REVERSIBLE and can go into surgery
4-6 hours Parasthesia w/muscle tenderness
This signifies that the clock is ticking and you need to hurry the fuck up
6-8 hours Paralysed w/numbness
This is a non-viable limb
What is the clinical difference between acute ischaemia and acute venous disease?
Acute venous disease seems to be swollen, hot and tender whereas, in ischaemia, the limb is neither of these things
What are the pathogenic causes of acute limb ischaemia?
Athersclerosis + thrombosis Embolus (cardiac/aneurysm) Thrombosis (thrombophilia, graft occlusion, aneurysm) Dissection Trauma
